The problem with phone medicine is that you have to trust what you hear and act accordingly.  Diagnosing an illness is a multi-dimensional process which incorporates four of the five senses.  Phone medicine limits you to the use of only one, hearing, and relies on your patient’s ability to accurately describe what is happening on their end of the phone.

Patient’s mom: “My son is sick.  He’s throwing up and has a history of throwing up on a regular basis since childhood.  I need a refill on his medication.”

Doc: “It’s been 9 months since he’s been seen.  Why don’t you bring him in now and let me examine him.”

Mom: “I just need his pill.  His brother is vomiting and it’s making him sick.  I can’t leave his brother and can’t come in.”

Doc: “The fact that his brother is also sick makes me want to see both of them.  We are open late tonight.  Please bring them in now.”

One of the harder things I have to do as your doc is be insistent about not treating you over the phone.  Diagnosing an illness is tricky even when I can use my four senses; it can be impossible over the phone.  Making a mother pack up her sick kids and come into the office can seem uncaring, even cruel.  Unfortunately, it’s necessary.

This mom was right.  Her son has cyclical vomiting, an illness that causes repetitive bouts of vomiting.  Moms are usually right and their opinions are extremely valuable.  This mom was wrong.  This time, her child’s vomiting was not from cyclical vomiting; her child had developed migraines and had been having headaches for months.

The diagnosis was easy.  When I first saw my patient, he was lying in a darkened exam room.  When I turned on the lights, he cringed and turned from the light.  Either he’s a vampire or he has a significant headache.  Further questioning and exam led to a diagnosis of adolescent onset migraine and the treatment worked.  My patient was improved prior to leaving the office and will do well.

Had I treated his vomiting over the phone, I would have missed the diagnosis of migraine.  He would have continued to have headaches and vomiting episodes.  He would have missed more school, spending days in a dark room lying in bed.   At least now, he can learn to control and treat his illness appropriately.

Remember, four senses are always better than one.  Be sensible.  If you are sick or your kids are sick, see your doc.  The life you save may be your own.

Stewart Segal is a family physician who blogs at Livewellthy.org.

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